POS1112 COMBINED BIOLOGICAL OR TARGETED THERAPY IN SPONDYLOARTHRITIS: EXPERIENCE FROM A MULTICENTER CASE SERIES IN SPAIN
Authors: C. Valero, J. Font Urguelles, M. Sallés Lizarzaburu, B. Joven-Ibáñez, A. De Juanes, J. Ramirez, X. Juanola-Roura, R. Almodóvar, A. Laiz, M. Moreno, M. Pujol Busquets, E. Beltrán, J. A. Pinto Tasende, L. Crespi Martinez, L. Sala-Icardo, S. Castañeda, R. Garcia-Vicuna
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Combined biological or targeted therapy (CBTT) is rarely considered in clinical practice due to not being recommended in clinical guidelines, potential safety concerns and high costs. Successful experiences have been found with CBTT in refractory patients with inflammatory bowel disease (IBD). Previous early data in selected refractory spondyloarthritis (SpA) have shown encouraging results<sup>1</sup>. <h3>Objectives</h3> Our aim was to assess real-world effectiveness and safety of CBTT in a wider SpA population. <h3>Methods</h3> This is a retrospective multicenter study. We identified patients with SpA and simultaneous combined use of two biological or targeted (excluding apremilast) agents with different therapeutic targets since 2017. All patients fulfilled axial or peripheral SpA ASAS criteria and signed written informed consent. Demographics, clinical, laboratory, and safety data were collected from electronic medical records. Cut-offs for remission/low activity criteria for axial-peripheral disease were ASDAS-CRP &lt;1.3/&lt;2.1 or DAS-28-CRP&lt;2.6/&lt;3.2 or DAPSA&lt;4/&lt;14, respectively. Major clinical improvement (MCI) was defined as a change in ASDAS-CRP&gt;2 and DAS-28-CRP&gt;1.2 units and improvement of &gt;85% in DAPSA. <h3>Results</h3> A total of 39 CBTT courses were identified in 35 SpA patients (Table 1). The main indication for CBTT was active musculoskeletal disease (Table 2). Three patients presented remission or low SpA activity at baseline and were excluded in the efficacy SpA analysis. Most patients (89.7%) had previously failed at least one of the two therapies used in CBTT. The most common combination was TNF inhibitor plus IL12/23 inhibitor agent (n=20; 51.2%). Median exposure to CBTT was 16 months (IQR 11-24). At last follow-up, we observed a significant mean reduction in ASDAS-CRP (2.07; 95% CI: 1.31-2.83; p=0.001). Remission/low activity rates were 52.7%, and 61.1% (n=22) reached MCI. In a bivariate analysis, patients who reached MCI had a lower baseline ASDAS-CRP than those who did not (4.33 vs 6.20, p=0.052). Nine patients discontinued CBTT due to inefficacy, seven of them because of IBD activity. In 39 CBTT courses, 4 serious AE were identified in only 3 patients: non-infectious pulmonary infiltrates, a staphylococcal bacteremia and a patient with cytomegalovirus colitis and esophageal candidiasis. <h3>Conclusion</h3> Our preliminary results suggest that CBTT might be a feasible alternative in selected refractory multidomain SpA patients, with acceptable effectiveness/safety ratio. Prospective wider studies are warranted to confirm these data. <h3>Reference</h3> [1]Valero-Martínez C et al. ARD. 2022;81(6):899-901. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.